Should your child’s heart be monitored when taking Adderall?

In 2005, the health system in Canada suspended the sale of Adderall XR (amphetamine mixed salts) due to issues surrounding stimulant medication and the risk of sudden death in cardiac patients. The FDA shortly thereafter put a warning label on the use of Adderall and Canada reinstated use of Adderall XR with a warning label.

There have been many questions about what this warning means and how should a physician or concerned parent proceed when this medication is used. Initially the American Heart Association recommended that any child who was to be put on stimulant medication should be screened with an ECG before starting the medication. This would have been an overwhelming task for physicians because of the high number of patients who take the drug and a limited amount of cardiologists in a given area who need to monitor the results. In addition it would cause a significant increase in cost to healthcare if this was performed. The American Academy of Pediatrics looked at the data and evaluated the AHA recommendations. In May of 2008, they made a policy statement that recommended that children who were to be put on stimulant medication could be done so without a routine ECG unless there was a history of cardiac abnormality. If they did have such history, input from a pediatric cardiologist could be obtained, and if the primary care physician felt it was indicated, should be obtained.

The answer to these questions really boils down to a risk-benefit ratio. That means that if the benefit of treating ADHD outweighs the risks of the complication, then treatment for ADHD should proceed. Remember the risks of untreated ADHD include increase in chance of car wrecks, substance abuse, anxiety, depression, poor self-esteem and school failure. The data at this time does not fully indicate that use of stimulant medication really statistically increases the risk of sudden death syndrome over the average population who are not on medication.

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ABOUT THE AUTHOR

Donna Krutka, MD

Dr. Krutka is a board-certified pediatrician who works in private practice in Tulsa, Oklahoma. Her practice includes all ages of patients from newborns to young adults. Her areas of interest include attention...read more

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